Psychosocial care by general practitioners - Where are the problems? Results of a demonstration project on quality management in psychosocial primarycare

Objective: Since 1987, psychosocial services have been a part of the primar y care setting in Germany. In the framework of an eight-center national dem onstration program, problems in the diagnosis and therapy of psychosocial p roblems and psychosomatic disorders were assessed. Methods to improve quali ty were also implemented. Method: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms we re documented. Differences between psychosocial strain, treatment, and outc ome were determined by analyses of variance. Results: Anxiety (62%), depres sion (51%), and marital/family conflicts (44%) were the most frequent sympt oms. Psychosocial treatment was offered more often to those patients who ha d the highest level of anxiety and depression. Patients with pain and witho ut a psychological attribution to their illnesses were offered less psychos ocial treatment and suffered worse results. Partners and family members wer e rarely integrated into therapy. The procedures employed to improve outcom e were quality circles, family-oriented case conferences, consultation serv ices, and collaborative groups. Conclusions: These initial results are prom ising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic sy mptoms without psychological attribution may need special psychosocial inte rventions to improve their outcomes.